Hello from Cleveland Equine Clinic. We have had some very busy past few weeks. This past week we were presented with an unusual case. A 14 year old quarter horse, ADR (ain't doin right). The owners were concerned that he was eating thorny plants on the property, and he had not drank or ate for the past 24 hours. He has not been vaccinated and had a BCS of 3.5/9. Upon arrival to the clinic he had a heart rate of 93bpm, pale mucus membranes, and looked very dull and quiet. Auscultation revealed a complete lack of borborygmi (gut sounds), and slightly increased lung sounds on the right. Rectal palpation indicated a gas distension on the right side.
A fast scan of his abdomen was performed and primarily revealed non-motile and dilated small intestinal loops. He also had some anatomic anomalies. His left kidney was more ventral than expected and his right kidney more dorsal. On the right side, small intestine was seen more cranial than normal, and still non-motile. The stomach was also very prominent on the left side (most likely due to the increased fluid content within).
A NG tube was placed and approximately 3 gallons of fetid material was refluxed from his stomach, and he immediately perked up. He was brought into the ICU for the safety of the other horses in the clinic, and was catheterized for fluids. He received a bolus of 10 L of LRS with CMPK (due to a low calcium on bloodwork), and then was given a continuous rate of 1L per hour. He was placed on K-penicillin, banamine and gentacin. The NG tube was left indwelling, and he was refluxed about every 2 hours, resulting in less and less material until 10:0PM, then the tube was pulled at 3:00AM that night. Fluids were discontinued the next afternoon. He was ultrasounded again the next day and he showed mild improvement as his small intestine was back into a more normal position and was starting to contract and have peristaltic waves, all be it not fully yet. Though now, he began to develop a fever of unknown origin. This was handled using banamine, although he began to regulate his temperature on his own, without use of drugs. As of today (6/27/16) he has begun to develop a slight pleural pneumonia. There are some comet tails on ultrasound of his lungs and very slight fluid. Comet tail artifacts are a result of fluid accumulation in the interlobular septa of the lung. Lung radiographs were also taken and indicated only inflammation of the lungs. The horse's serum amyloid A has and is currently rising throughout his stay. There is a clear inflammatory process occurring, but it is yet to be known the exact cause of all of his problems. The pneumonia could be a result of aspiration from being refluxed, however it could also be coincidental as he did come in with slightly increase lung sounds. I am very interested to see if we can learn what his primary problem is and what is causing all of his problems. This case of enteritis, ileus, fever of unknown origin, and now pneumonia has really challenged me to think about all of the differentials and diagnostics that can be done in cases such as this. It has also given me a chance to really appreciate and learn abdominal and thoracic ultrasound. I was given the opportunity to scan him myself and was able to get some images of intestine and lung. We will see how he does and what develops over the next few days.
-Roya Oliai
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